SAP S016224, CENTERLINE AND EDGE STRIPING

SEE ATTACHMENTS

Office of County Commissioners
Finance Department
130 Jacob’s Way, Suite 302, Clarkesville, GA 30523
706-839-0200 Fax 706-839-0219
accountspayable@habershamga.com
Vendor Application Return Document Checklist (Please Initial).
Required by all vendors:
_____ Completed Vendor Application.
_____ Completed W9 Form.
_____ Vendor Affidavit Agreement (E-Verify).
*If not legally required to participate in the E-Verify Program, the following are
required.
_____ Private Employer Affidavit.
_____ Copy of state issued photo identification (Driver’s License, Passport, etc.).
Insurance Requirements:
_____ Copy of your Company's most recent Insurance Certificate(s) (Must be kept
current, see attached explanation of insurance requirements).
Optional Forms:
_____ Completed ACH Payment Approval Form (Optional, fill out if you wish to receive
vendor payments through automated fund transfer).
_____ Bidder List Application (This is help us contact you directly for future bidding
opportunities).
**If any required forms are returned incomplete, Active
Vendor status will not be granted, and subsequent payments
may be delayed. Please remember that documents requesting
notary verification must be notarized to be considered
complete. **

Form W-9(Rev. March 2024)
Request for Taxpayer
Identification Number and Certification
Department of the Treasury
Internal Revenue Service Go to www.irs.gov/FormW9 for instructions and the latest information.
Give form to the
requester. Do not
send to the IRS.
Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.
Print or type.
See Specific Instructions on page 3.
1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregar